Targeted therapy

A targeted therapy helps your body control the way cancer cells grow. There are different types of targeted treatment that destroy cancer in different ways. You may also hear it being called biological therapy.

Targeted therapy can be used on its own or with chemotherapy.

Access to targeted therapies

Not all targeted therapies are available on the NHS in England, Scotland and Wales, or the Health and Social Care service in Northern Ireland. If your doctor thinks you might benefit from this type of treatment, they will discuss it with you. Your cancer specialist can apply for funding for a treatment if you both agree that you would benefit from it. This can be a difficult process and it's not always successful.

Macmillan Cancer Support has information on what to do if a treatment isn't available.

Who can have targeted therapy?

Targeted therapies don't work for everyone. Your healthcare team might offer you a test to help find out if there are any targeted therapies that could work for you. This is called a biomarker test. The test could be a blood test or a test on a sample of your tumour from a biopsy.

Speak to your healthcare team to see if a biomarker test is appropriate for you.

Biomarkers

Your cancer cells may have changes (mutations) in sections of your DNA called genes. These changes are described as biomarkers. They can affect how the cancer grows. The most common mutations found in bowel cancer are in genes called RAS, BRAF and mismatch repair (MMR) genes.

The biomarker test is used to see if you have mutations in RAS, BRAF and mismatch repair genes. Finding out which mutations you have can help decide which treatment is more likely to work for you.

RAS genes

RAS genes help cells grow, survive and multiply. If the cancer has a normal RAS gene, it is known as RAS wild type. If it has a mutation, it is called a mutated RAS gene. There are different types of RAS genes called KRAS and NRAS. You may have a test to see if you have mutations in both of these RAS genes.

If you have the wild type RAS gene, you may be able to have the targeted treatments, cetuximab or panitumumab. These treatments are not suitable for patients with mutated RAS genes.

BRAF genes

BRAF genes help cells grow and multiply. If the cancer has a normal BRAF gene it is known as BRAF wild type. If it has a mutation, it is called mutated BRAF. The most common mutation is called BRAF V600E.

If you have the wild type BRAF gene, you may be able to have cetuximab and panitumumab. If you have the mutated BRAF gene, the drugs cetuximab and panitumumab are unlikely to work. If you have the BRAF V600E mutation, you may be able to have the drugs cetuximab with encorafenib and/or binimetinib.

Mismatch repair genes

Some bowel cancers develop due to mutations in the genes that usually repair DNA. These are known as mismatch repair genes (MMR). These bowel cancers often have a high number of mutated genes. This is referred to as deficient mismatch repair (dMMR) or MSI-High.

If you have this type of mutation, you might be able to have the immunotherapy drugs nivolumab or pembrolizumab.

Types of targeted therapy

A targeted therapy helps your body control the way cancer cells grow. There are different types of targeted treatment that destroy cancer in different ways.

Cetuximab (Erbitux®)

You may have cetuximab if you have a wild type RAS gene. It is given to you through an infusion or drip into a blood vessel in your arm or hand. You will have it once a week. You may have this alongside chemotherapy.

Panitumumab (Vectibix®)

You may have panitumumab if you have a wild type RAS gene. It is given to you as an infusion into a blood vessel into your arm or hand. You may have this alongside chemotherapy.

Bevacizumab (Avastin®)

You may have bevacizumab given to you as an infusion through a drip into your vein. This can be every two or three weeks. You are likely to have it alongside chemotherapy.

Encorafenib (BRAFTOVI®)

You may have encorafenib, alongside the drugs cetuximab and/or binimetinib, if you have the BRAF V600E mutation. It is given to you as a tablet that you take once a day.

Aflibercept (Zaltrap®)

You will be given aflibercept as an infusion through a drip into your arm. You’ll receive it every two weeks.

Regorafenib (Stivarga®)

You will have regorafenib as a tablet that you can take once a day for three weeks. After this you will have a week off therapy, before starting the treatment cycle again.

Ramucirumab (Cyramza®)

Ramucirumab is given to you as an infusion through a drip into your vein. You are likely to have it alongside chemotherapy. You will receive it every two weeks.

Some of these treatments haven't been approved for use on the NHS (in England, Scotland and Wales) or the Health and Social Care service (in Northern Ireland). Speak to your healthcare team to find out if you can have these treatments.

Side effects

Like most treatments, targeted treatments can cause side effects. Many of them will stop once you have finished treatment. Speak to your healthcare team if you are worried. They will be able to help you manage them.

Common side effects can include:

• tiredness (fatigue)
• diarrhoea
• feeling or being sick (vomiting)
• rashes on your skin
• rapid or uncomfortable breathing
• weight loss or loss of appetite
  
  

New treatments

Research is ongoing to try and find new targeted treatments for advanced bowel cancer. These therapies may not always be available through the NHS but they may be available through a clinical trial.

Not everyone is suitable for clinical trials. Speak to your healthcare team to discuss these options.

Immunotherapy

There is lots of research looking into new immunotherapy drugs. Immunotherapy is a type of targeted treatment that helps your own immune system to destroy the cancer. Some patients may be able to have them by taking part in clinical trials. Immunotherapies don’t work for everyone.

Nivolumab (Opdivo®)

You will be given nivolumab as an infusion through a drip into your arm. You may have it on its own or you may have it combined with another drug called ipilimumab. You may be able to have it if your bowel cancer has changes (mutations) in mismatch repair genes (dMMR).

Pembrolizumab (Keytruda®)

You may have pembrolizumab as an infusion through a drip into your arm. You may be able to have it if your bowel cancer has changes (mutations) in mismatch repair genes (dMMR).

More information

You can find more information about targeted therapy for advanced bowel cancer on the Cancer Research UK website.

Join our online community – a welcoming place for everyone affected by bowel cancer to ask questions, read about people’s experiences and support each other.